Theory on 'new' cannabis hyperemesis syndrome

[permastoned]

http://www.news.com.au/story/0,27574,25229881-421,00.html

Cannabis users 'suffering new syndrome'
By Danny Rose
AAP
March 23, 2009 05:47pm

THERE is mounting evidence to support the existence of a new syndrome afflicting heavy cannabis users, after the world's first cases were found in South Australia.

The condition "cannabinoid hyperemesis" was first identified in a group of about 20 heavy drug users in the Adelaide hills in 2004, and a new case has emerged this time in the US.

The syndrome is characterised by nausea, stomach pain and bouts of vomiting - ill effects which, oddly, sufferers say they get some relief from by taking a how shower or bath.


The new case, involving a 22-year-old man in Omaha, is published in the World Journal of Gastroenterology where doctors were also told to consider it when treating people with unexplained vomiting.

"Given the high prevalence of chronic cannabis abuse worldwide and the paucity of reports in the literature, clinicians need to be more attentive to the clinical features of this under-recognised condition," writes Dr Siva Sontineni, and colleagues, from the Creighton University Medical Centre.

In the US case, the sufferer had been smoking marijuana daily and in heavy doses for six years. This eventually led to bouts of vomiting lasting two to three hours daily, and this was worse after meals.

As with South Australian cases, the young man initially turned to "compulsive hot bathing behaviour" to relieve the symptoms but he was not cured until he gave up smoking cannabis altogether.

Adelaide-based drug expert and emergency ward doctor, Dr David Caldicott, said he had seen three cases of the illness and it was possibly also under-reported by sufferers.

"We're probably seeing the tip of the iceberg in the emergency departments, it's probably far more common but far milder (in the broader community)," he said.

Little was known about how cumulative cannabis use could lead to vomiting and, particularly, why sufferers would find some relief in hot bathing, Dr Caldicott also said.

"That's a distinct and unanimously recurrent feature of this condition, and we don't know why," he said.

"Grown men, screaming in pain, sweating profusely, vomiting every 30 seconds and demanding to be allowed to use the shower. It's a very dramatic presentation."

Dr Caldicott said the condition had been identified in a small number of cannabis users "but in the medical community it is now considered to be a real condition".

The National Cannabis Prevention and Information Centre, based at the University of NSW, is taking a more conservative approach.

Centre director Jan Copeland said more cases would need to emerge before it could be considered a new syndrome linked to chronic cannabis use.

"It is not unusual for there to be significant mental and physical health complications with this level of cannabis use," Professor Copeland said.

For more information on cannabis, the centre has a free national helpline 1800 304050.

I read this article last night and decided to write a theory for it because (ironically) i was quite heavily stoned, the weed was making all my hypotheses sound far more amazing than they were.

Serotonin is involved in hyperthermia right, we know this from E. Dopamine is also be involved. These neurotransmitters are also involved in the production of the sensation of nausea. Increased concentrations of dopamine and serotonin in the chemoreceptor trigger zone cause the sensation of nausea.

(http://en.wikipedia.org/wiki/Chemoreceptor_trigger_zone)

Now it may be possible that excessive CHRONIC cannabis use is causing an increase in the release of these NTs. This is especially so considering the mechanism of action of cannabinoids is to reduce the release of neruotransmitters throughout the brain (both excitatory and inhibitory).

:
Conventional neurotransmitters are released from a ‘presynaptic’ cell and activate appropriate receptors on a ‘postsynaptic’ cell, where presynaptic and postsynaptic designate the sending and receiving sides of a synapse, respectively. Endocannabinoids, on the other hand, are described as retrograde transmitters because they most commonly travel ‘backwards’ against the usual synaptic transmitter flow. They are in effect released from the postsynaptic cell and act on the presynaptic cell, where the target receptors are densely concentrated on axonal terminals in the zones from which conventional neurotransmitters are released. Activation of cannabinoid receptors temporarily reduces the amount of conventional neurotransmitter released. This endocannabinoid mediated system permits the postsynaptic cell to control its own incoming synaptic traffic. The ultimate effect on the endocannabinoid releasing cell depends on the nature of the conventional transmitter that is being controlled. For instance, when the release of the inhibitory transmitter, GABA, is reduced, the net effect is an increase in the excitability of the endocannabinoid-releasing cell. Conversely, when release of the excitatory neurotransmitter, glutamate, is reduced, the net effect is a decrease in the excitability of the endocannabinoid-releasing cell.

Over the longterm, this constant decrease of neurotransmitter release will naturally result in an upregulation of certain receptors including the dopamine and serotonin receptors. At the same time the cannabinoid receptors are downregulating due to excessive use. So what you get is the amount of receptors for serotonin and dopamine increasing and the number of receptors for cannabinoids decreasing. This means that eventually the cannabis is going to have a greatly reduced effect, meaning it will no longer causes a sufficient enough activation of cannabinoid receptors to suppress neurotransmitters release significantly, and because the receptors for these neurotransmitters have been greatly increased, it means that there will be a greatly increased serotonergic and dopaminergic action in the chemoreceptor trigger zone causing nausea.

Now, going back to serotonin causing hyperthermia, an increase in the level of serotonin in the brain causes hyperthermia. When the body temperature increases, e.g. someone gets in a bath, the body starts to get too hot for it to be at the optimal functioning temperature, and thus changes the 'set-point' in the hypothalamus of the brain. This causes the hypothalamus to decrease the levels of secretion of serotonin and dopamine, resulting in a decrease of body temperature, and also a decrease in the sensation of nausea as a side effect.

Yep, I know it's bullshit.

 

[LuxEtVeritas]

holy shiznit as i know someone who for no explained reason has been vomiting in this manner and indeed is a heavy cannabis user, at least as I am informed....hmmmm

 

[fatstep]

I have a friend who is pregnant and she has been hospitalized throughout her pregnancy for hyperemesis. Believe it or not the doctor(who's a friend or my family as mom's a doctor too) told her cannabis could help solve it by relieving the nausea and vomiting as well as helping with appetite.
Seems this study got shit backwards -_-

 

[LuxEtVeritas]

cannabis is well known for its antiemetic effects...

thus this is odd in that respect, but moreso in why is this only a new occurrence as cannabis of course has been used and 'abused' for many decades/centuries...that is the questions and perhaps within that is the answer

is it certain new strains that are having some effect on pathways to a degree not seen with the older strains?

 

[permastoned]

Re new strains: Possibly, but more likely it would have just been misdiagnosed, because it wasn't known about til now. I assume the link that made the doctors put 2 and 2 together was the common presentation of needing to get into a hot bath to relieve the symptoms.

 

[MurphyClox]

Only a gutfeeling - but I would think that these symptoms occur due to impurities in the weed, maybe certain pesticides or something. Sorry that I can't back up this opinion with more info.

Why haven't we seen more reports much earlier? Weed was used for centuries, if not millennia, and I would guess that these Aussies are not the first "heavy stoners" in history...

- Murphy

 

[LuxEtVeritas]

exactly

new impurities of some nature would also be a possibility along with new strains and indeed may be more likely than the latter


for whatever it is worth it appears it must be something new to the current weed itself in the manner alluded to above

 

[Hammilton]

Well, I wouldn't be surprised if today we have heavier stoners than ever before. We have certainly been breeding higher potency strains, and our consumption habits have changed substantially to the point where there are reports of idiots going through more than 3.5 grams in a day every day.

I think it's related to TRPV1 receptors which are involved both with emesis and the sensation of hot and cold.

 

[LuxEtVeritas]

i have to think through the history of use of cannabis there have always been a percentage of reasonable number that used high levels

most people will only look to get so stoned and maintain it, even 'abusers', not like a drug that drive one to re-dose and can lead to more dangerous acute levels and psychosis or similar

though your post has merit to at least consider that pathway

 

[vortex30]

i have to think through the history of use of cannabis there have always been a percentage of reasonable number that used high levels

most people will only look to get so stoned and maintain it, even 'abusers', not like a drug that drive one to re-dose and can lead to more dangerous acute levels and psychosis or similar

though your post has merit to at least consider that pathway

But when we consider we have something like 10x the number of people on Earth than we had just 250 years ago and 20x the number of people 1,000 years ago, with Cannabis now popular in most regions of the Earth unlike 100 years ago, you realize there are FAR MORE people smoking the 3.5g/day than there were in past centuries/millenniums, thus the incidence level would be higher. This along with better recording and a sense of what is actually going on in Australia, for example, will lead to more known cases. If this is indeed caused by excessive Cannabis use, I would imagine maybe in the past few millenniums there were a few cases, but it was probably not recorded, or lost in time, or so sporadic that Cannabis was never blamed.

Another possibility is the racial profile of the so far affected people compared with cultures that have historically used Cannabis (Asia and Northern Africa only). It could be something to do with that though I highly doubt this theory of mine.

I think it is an adulterant, the new strains, or simply the fact that we have so many more people smoking Cannabis on a world scale presently than ever before in history.

 

[any major dude]

the close geographic proximity of the first group of cases makes me think it could be due to a pesticide or some other adulterant. Also, given all the new cannabis growing techniques, it probably wouldn't be all that outlandish to suppose that some type of fertilizer could be to blame. Definitely needs to be studied further though.

A bit of anecdotal evidence from my own life: One good friend of mine, and pot smoking buddy, persisently dated crazy girls. 2 of said girlfriends had a reaction of this type to marijuana, and both of them were bipolar. 1 was diagnosed and on meds when this happened, the other wasn't diagnosed til years later, but definitely had all the characteristic bipolar behaviors when the reaction occured.

 

[LuxEtVeritas]

^ yes, are there any similar pre-existing psychological characteristics of those affected?...hence why it is so rare...

 

[any major dude]

I recently saw a documentary about australian pot smokers with either underlying psychological conditions and/or histories of mental illness in the family. The doc was definitely anti-pot, and tried to correlate weed with mental illness. I thought it was a bit of a flawed premise given that the subjects of the doc all had underlying conditions. Granted the pot may have exacerbated things, but nonetheless, saying pot causes mental illness in people with mental illness seems a bit strange.

Is there a lot of anti-drug propoganda coming out of australia now? I'm completely ignorant of australian politics

 

[mad_scientist]

I had a doctor friend in Australia ring me up the other week about this as it happens, saying they had a patient in with chronic cyclic vomiting secondary to cannabis use...reckoned they'd dosed her up with metoclopramide, ondansetron and tropisetron but she was still vomiting everywhere, and they didn't have cyclizine in stock in their small rural hospital so he was running out of ideas! I suggested they try rimonabant....

 

[Hammilton]

Did it work? It seems backwards; how often does one go to the cannabinoid antagonist to stop vomiting? It's like prescribing thioridazine to increase focus and energy.

I know that hot showers are commonly described as helping spincter of Oddi maladies; given the difficulty in diagnosing this, it seems like it might be a possible explanation.

But then discontinuation wouldn't relieve symptoms. Or would it? Is cannabis known to effect the spincter of Oddi?

 

[any major dude]

As far as I know activity at either CB1 or CB2 doesn't affect the musculature in the GI tract. This new phenomenon could suggest otherwise though.

Is it possible that there could be some sort of endocannabinoid disorder or imbalance that would result in converse effects from intake of external cannabinoids, a la ADHD treatment with amphetamine salts or methylphenidate?

 

[Ceres]

I don't know wether this is useful or relevant but when I was a chronic weed abuser, in the last year or two of daily, heavy smoking of herbal cannabis, I would occasioally suffer periods of unexplainable, constant nausea lasting 3 to 4 days. The nausea was bad enough that I felt I couldn't leave the the house and was constantly getting up and going to the bathroom believing I was about to vomit, but never actually did. Nothing I tried would make the nausea go away. I suffered these bouts perhaps 3 times a year.

At this point in my addiction I was experiencing insidious social paranoia to the extent that I believed all my friends were openly ridiculing me when I was in the room with them and so on, I truly feared for my mental health which is why I stopped.

I quit smoking weed on a daily basis over 3 years ago, and rarely indulge, maybe once a year if I happen to come into posession of a gram or two. I cannot smoke it socially anymore. I have never had that nausea problem in the whole period where I stopped smoking it. Obviously this isn't evidence of anything, it may even have been completely unrelated or caused by some other illness, but I do strongly feel the nausea was caused by the cannabis use.

My weed came from various sources who had various suppliers, I was never smoking one particular batch or stuff from one particular grower consistently, so I couldn't possibly correlate the sickness with any particular grow method or possible nutrients being used in the system.

Sorry for rambling, the article just struck a chord with me and my experience of unexplainable nausea.

 

[GraffDOOM]

I'll say this is definitely real, and I have it. Won't get into tons of details, but I've experienced the same patterns, same triggers, same everything over the past year or so. The only thing that I didn't experience was the bathing, but that's more because I never considered it as an option. Usually the pain was just overwhelming, and I'd end up in the ER (couldn't even keep down the painkillers they gave me, only IV would do the trick).

Since I began obstaining, the symptoms have gone away. Actually kind of a bummer, it would be nice if I could still use every now and then (I used to use 2-4 times a day).

permastoned, your theory actually makes a ton of sense (to the point that I registered here specifically to reply). Here's what I'm wondering: if use is scaled back to say, 1-2 times a week as opposed to my previous daily use, would these symptoms still come back? I've had very small use over the past month or so with no problems, but at this point I figure I'll wait a month for it to get out of my system, and see what happens after that with less regular use, only on the weekends.

Curious to know if anyone else has the same symptoms, and/or if they've found any level of use that's safe.

 

[GraffDOOM]

And FYI, this is a symptom of decreased motility, from what I've read. Basically if you load up on pot, your guts freeze to the point that there's kind of a "bounce back" effect once it wears off, if that makes sense. From my experience, that definitely explains it.

This only affects a small percentage of people, for sure. Too bad I'm one of them

 

[Pimp Lazy]

Man it sounds like classic poisoning symptoms. It's the strongest and most remembered response the body has. You know how people can get sensitization allergies from touching certain materials a lot might be something like that as well. There are a lot of things that happen when you put drugs into your body and it is not as simple (i tried spelling 'simple' 3 differet ways… my poor stoned bipolar head) as more receptors equals more effect. Some SSRI's desensitize one of the 5-HT receptors in the dorsal periaqueductal gray (sp?) and as well as lead to an increase in density and some do one but not the other and some have the complete opposite effect.

If you're hypothesizing that serotonin is the culprit then these would be discontinuation symptoms (read as: withdrawal) not something from smoking excessively. But all the same GraffDOOM seems to have cannabinoid hyperemesis' number. I wonder how many people "have a friend with this" in places that haven't popularized it or documented it. All the same I wonder if people can have it at times in their life and not others depending on their natural cycle. I've gone through bouts of throwing up where I'll basically cough a normal cough and then start throwing up. I normally associate it with extreme stress and being awake for days on end for natural or unnatural reasons. I'm still curious about this.

Peace,
PL